HEALTH

When approved by your doctor, supplementing can help you balance nutritional deficiencies, but there may be health hazards to overdoing it. Stocksy

TAKING TOO MANY SUPPLEMENTS? HERE'S HOW TO TELL, AND WHY IT CAN BE RISKY

BY: LAUREN BEDOSKY & MEDICALLY REVIEWED BY JUSTIN LAUBE, MD
SITE: EVERY DAY HEALTH

Supplements have exploded in popularity over the past two decades, but a lack of regulation, and a spike in the amount of products available, may be leading people to overdo it.

If you’ve changed your supplement routine since the pandemic, you’re not alone. According to a 2020 survey conducted by the Council for Responsible Nutrition (CRN) , more than 43 percent of dietary supplement users have switched things up. Among those who updated their regimens, 91 percent reported increasing their supplement intake, either by adding new supplements, taking the same supplements more regularly, or upping their dose(s). Overall immune support and health and wellness benefits are cited as the top reasons.

And supplementing is only becoming more popular. National Health and Nutrition Examination Survey data published in February 2021 shows 57.6 percent of people have taken a dietary supplement in the past 30 days, and all age groups surveyed report higher supplement use from data collected in 2007–2008. But while supplements are often seen as a method to ensure you meet your daily nutritional needs, they can create problems if you’re not careful. Like drugs, dietary supplements can affect the way your body functions, which can cause adverse effects in some people, according to an article published in the May 2022 issue of U.S. Pharmacist .

For example, on June 21, 2022, the U.S. Preventative Services Task Force (USPSTF) issued an official recommendation published in JAMA Network against using beta carotene or vitamin E supplements for the prevention of cardiovascular disease (CVD) or cancer. According to the USPSTF, increased inflammation and oxidative stress may encourage the development of CVD and cancer, and some dietary supplements have anti-inflammatory and antioxidative properties to help in the prevention of both health concerns. However, the report clarified that vitamins containing beta carotene and vitamin E likely won’t forestall either. The USPSTF held off on making recommendations around the use of multivitamins and single- or paired-nutrient supplements (other than beta carotene or vitamin E) for the prevention of CVD and cancer due to insufficient evidence.

Bottom line: Supplementing guidelines are tricky and ever evolving, and the supplements consumers take may not be the “cure all” marketers often promise. So, how do you know if you’re overdoing it with the supplements? Read on to find out.

What Are the Potential Health Benefits of Supplements?

“[In general], a supplement is something you’re not getting enough of through food,” says Rohit Moghe, PharmD, CDCES, a pharmacist with Trinity Health Mid-Atlantic in Philadelphia, and member of the American College of Lifestyle Medicine (ACLM) .

To fill in these nutrient gaps, many people turn to gummies, capsules, powders, tinctures, and even saline solutions delivered via needle (known as IV therapy).

In the Dietary Supplement Health and Education Act of 1994 , Congress defined supplements as products (other than tobacco) that are intended to supplement the diet, contains one or more dietary ingredients (including vitamins, minerals, herbs, botanicals, amino acids , or other substances) or their constituents, is intended to be taken by mouth as a pill, capsule, tablet, or liquid, and is labeled as a dietary supplement.

While many people are able to meet their nutrient needs through their diet, others may benefit from supplements. Particularly those who face a greater risk of nutrient deficiencies, including those with higher requirements (like children, adolescents, and pregnant and lactating women), those who struggle to absorb nutrients (like older adults, obese individuals, and people with chronic conditions), and those who follow a restrictive diet (like vegans and vegetarians), according to an article published in January 2018 article in Nutrients .

For example, a vitamin B12 supplement may be a good idea for older adults and people who follow a vegan or vegetarian diet . Vitamin B12 helps keep your blood and nerve cells healthy, and plays an important role in making DNA, per the  National Institutes of Health (NIH) . It’s found naturally in animal foods, which means vegans and vegetarians may not get enough through diet alone. Older adults may also be deficient in vitamin B12, because many don’t have enough hydrochloric acid in their stomach to absorb it, according to the NIH. Therefore, both groups might benefit from a vitamin B12 supplement.

What Are the Risks of Supplements?

A common concern about supplements is that the industry, in general, is under-regulated. Unlike medications, supplements don’t have to be approved by the U.S. Food and Drug Administration (FDA) before they’re sold or marketed.

New legislation, proposed by Senate Majority Whip Dick Durbin, a Democrat from Illinois, and Sen. Mike Braun, a Republican from Indiana, aims to improve the safety of dietary supplements by requiring manufacturers to list their products with the FDA under the Dietary Supplement Listing Act of 2022 — a bipartisan initiative. The new legislation, which refers to the Dietary Supplement Health and Education Act of 1994, points out that in 1994 there were about 4,000 dietary supplements marketed in the United States, but the industry has boomed and now 50,000 to 80,000 products are available.

In the meantime, consumers can’t be sure the supplements they’re taking are safe or effective.

Even if a supplement is considered generally safe, it may not be safe for you . “Most vitamins and minerals have a risk of harm with dosages, and the risk is based on the individual nutrient and patient,” says Ravi Tripathi, MD , medical director of critical care services for the Ross Heart Hospital at The Ohio State University Wexner Medical Center in Columbus. When it comes to supplements and risks, “there is no one size that fits all,” he says.

For example, people with an inherited condition called hemochromatosis have to be careful with iron supplements, as hemochromatosis causes toxic levels of iron to build up in their bodies, notes the  NIH . And while most people don’t get enough potassium even when diet and supplements are combined, according to the  NIH , people with chronic kidney disease can develop abnormally high levels of potassium in their blood. This condition, known as hyperkalemia , can cause serious heart problems if left untreated, according to the National Kidney Foundation .

Supplements can pose risks even in otherwise healthy people. According to the  NIH , you’re more likely to have side effects from dietary supplements if you take them at high doses or use many different supplements.

The symptoms from taking more supplementation that your body needs vary depending on the nutrient and the amount taken, and may only show up in blood tests. However, there are some physical signs to watch for. According to the May 2022  U.S. Pharmacist article, general symptoms to look out for may include:

• Headache
• Dizziness
• Severe weakness
• Nausea
• Tremor
• Constipation or diarrhea
• Inability to exercise or perform routine tasks

5 Common Supplements People Tend to Overdo

1. Vitamin D

Why it’s good for you: Vitamin D (also known as the “sunshine vitamin”) helps your body absorb calcium, making it a key nutrient for bone health. Your body also needs vitamin D to carry messages between your brain and your body and fight off bacteria and viruses, according to the NIH .

Why you might be overdoing it: On the one hand, 40 percent of Americans are deficient in vitamin D, per blood tests (when serum levels are less than 50 nmol/L), according to  findings published in June 2018 in Cureus . The reason? Most of us aren’t getting enough sunlight exposure, notes the NIH. Taking a vitamin D supplement may help — and the CRN survey shows this supplement is becoming more popular — but it’s important to watch your dosage to ensure you don’t get more than 100 micrograms (mcg) a day. According to the NIH, overdosing is almost always caused by taking supplements, as opposed to sunlight exposure or eating vitamin D–rich foods.

Risks: Very high levels of vitamin D can cause nausea, vomiting, muscle weakness, pain, loss of appetite, dehydration , and kidney stones , per the NIH.

2. Iron

Why it’s good for you: Iron is a mineral your body needs to make hemoglobin, a protein in red blood cells that carries oxygen throughout your body, according to the  NIH . It also helps your body make hormones.

Why you might be overdoing it: Iron supplements are often recommended for younger women to help offset iron lost during menstruation. But according to the  Cleveland Clinic , many women continue to take supplements containing iron after menopause, when menstruation stops and iron needs decrease.

Risks: Getting too much iron can cause gastrointestinal (GI) symptoms like constipation, nausea, vomiting, abdominal pain , and diarrhea, per the NIH. Overdosing on iron can also lead to inflammation of the stomach lining and ulcers . Although rare, extremely high doses of iron (in the hundreds or thousands of milligrams) can even cause organ failure, coma, convulsions, and death, according to the NIH.

3. Vitamin A

Why it’s good for you: According to the NIH , vitamin A is important for vision, immune health, reproduction, growth, and development.

Why you might be overdoing it: It’s pretty easy for most people to score plenty of vitamin A. If you eat cereal for breakfast and carrots or sweet potatoes at lunch, and then pop a supplement for eye health, you’ve probably gone over the recommended amount, says the Cleveland Clinic.

Risks: High levels of vitamin A can cause severe headaches, blurred vision, nausea, dizziness, muscle aches, and coordination issues, notes the NIH.

4. Vitamin C

Why it’s good for you: Vitamin C, also known as ascorbic acid, acts as an antioxidant, helping to protect your body from free radical damage. According to the  NIH , your body also needs vitamin C to make collagen, a protein that’s important for wound healing.

Why you might be overdoing it: The CRN survey found that vitamin C supplements have seen a big boost since the pandemic. However, most people can get enough vitamin C through food. In fact, 1 cup of strawberries, chopped red pepper, or broccoli will provide the daily amount needed, per Mayo Clinic .

Risks: Taking too much vitamin C can cause diarrhea, nausea, and stomach cramps, according to Mayo Clinic. Vitamin C supplements may also interact with cancer treatments like chemotherapy and radiation therapy, per the NIH. In addition, a past study found that men who took vitamin C supplements had a higher risk for developing kidney stones .

5. Calcium

Why it’s good for you: Calcium is a mineral that builds and maintains strong bones. It also plays a role in nerve function, circulation, and hormone release, according to the  NIH .

Why you might be overdoing it: You may be tempted to load up on calcium supplements to protect your bones, but according to the  Cleveland Clinic , it’s surprisingly easy to overdo it. Especially if you’re already getting calcium from your food.

Risks: Excess calcium has been linked to constipation, kidney stones, kidney failure, heart problems, and cognitive issues, according to the Cleveland Clinic.

How to Talk to Your Doctor About Supplements

Experts often recommend speaking with your doctor before trying a supplement. Unfortunately, many physicians and nurse practitioners aren’t as knowledgeable in this area. “I find many [healthcare professionals] are grossly unprepared to answer their patients’ questions, and they wind up telling them that supplements are a waste of money, when maybe there’s a product that may actually work for your intended use,” Dr. Moghe says.

If you’re interested in adding a supplement to your diet, Moghe suggests talking with a physician trained in integrative medicine or nutritional medicine, a pharmacist, naturopath, or registered dietitian. You can check the directories of the National Board of Physician Nutrition Specialists and the American Board of Physician Specialties to find a healthcare professional who works for your needs.

Simple blood tests can reveal if you’re deficient in specific nutrients, but the routine blood work at your annual physical doesn’t typically include these tests, although some nutritional deficiencies can produce changes on these labs, according to Rush University . You’ll have to request these blood tests when you visit your doctor. A physician trained in integrative medicine and/or nutritional medicine, a pharmacist, naturopath, or registered dietitian may be able to offer suggestions and a tailored approach to getting the right levels of nutrients for you, and explore whether it makes sense to test for specific vitamin deficiencies given your unique lifestyle, diet, and health.

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